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Posted by on Apr 9, 2017 in Leukemia | 0 comments

In a nutshell

The aim of this study was to compare conventional myeloablative therapy and reduced-intensity conditioning (RIC) before stem cell transplantation in patients with adult acute lymphoblastic leukemia (ALL). Researchers concluded that RIC is a suitable alternative for patients who may not tolerate myeloablative therapy.

Some background

ALL is a type of cancer in which the bone marrow makes too many lymphoblasts (a type of immature white blood cell). This type of cancer usually gets worse quickly if it is not treated. Chemotherapy is often the first-line treatment for ALL. Stem cell transplantation is considered the most effective therapy for ALL patients who have achieved complete remission after treatment.

High-dose chemotherapy delivered before a stem cell transplant is called myeloablative therapy. However, not all patients can tolerate conventional myeloablative conditioning. Older patients or those with additional medical conditions are particularly likely to experience serious side effects. As a less toxic alternative, patients may receive reduced-intensity conditioning (RIC). This is designed to suppress the patient's immune system enough so that it will accept the donor stem cells. Once the donor's cells take over the patient's bone marrow (a process known as engraftment), the immune system is better able to kill cancer cells. However, more studies are needed to compare conventional myeloablative therapy and RIC techniques. 

Methods & findings

The aim of this study was to compare myeloablative therapy and RIC before stem cell transplantation.

The records of 576 ALL patients were analyzed. 127 patients were treated with RIC. 449 patients receiving conventional myeloablative conditioning. After achieving complete remission, all patients underwent a stem cell transplantation with stem cells donated from a sibling. Treatment outcomes were followed for an average of 16 months.

The 2-year overall survival rate (proportion who have not died from any cause since treatment) across all patients was 46%. 37% of patients were leukemia-free at 2 years. No significant differences in leukemia-free survival were observed between the two treatment groups. 34% of patients experienced chronic graft-versus-host disease (when donor cells attack the organs of the patient). This was also not affected by treatment group.

29% of patients treated with myeloablative conditioning died without a documented disease relapse. This was significantly higher compared to patients treated with RIC (21%). Overall, the mortality risk (without documented relapse) was nearly twice as high for myeloablative conditioning.

However, the risk of relapse was 59% higher with RIC. The 2-year relapse rate for patients treated with myeloablative conditioning was 31%. This was significantly lower compared to patients treated with RIC (47%). 

The bottom line

Researchers concluded that RIC is a suitable treatment option for patients who may not tolerate conventional myeloablative therapy.

The fine print

Larger trials that randomly assign patients to treatment groups are needed to confirm these results.

Published By :

Blood

Date :

Nov 25, 2010

Original Title :

Reduced-intensity versus conventional myeloablative conditioning allogeneic stem cell transplantation for patients with acute lymphoblastic leukemia: a retrospective study from the European Group for Blood and Marrow Transplantation.

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